Healthcare Provider Details

I. General information

NPI: 1922146125
Provider Name (Legal Business Name): JOHN TIMOTHY KATZEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD STE. 407
BEVERLY HILLS CA
90212-2107
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD STE. 440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 310-859-7770
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-471-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG85745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: